Definition
A mastectomy is the surgical removal of the entire breast, usually to treat serious breast disease, such as breast cancer.
There are four general types of mastectomy:
- Subcutaneous mastectomy -- the entire breast is removed but the nipple and areola (the pigmented circle around the nipple) remain in place
- Total (or simple) mastectomy -- removal of the whole breast, but not the lymph nodes under the arm (axillary nodes).
- Modified radical mastectomy -- removal of the whole breast and most of the lymph nodes under the arm (axillary dissection)
- Radical mastectomy -- removal of the chest wall muscles (pectorals) in addition to the breast and axillary lymph nodes. For many years, this operation was considered the standard for women with breast cancer, but it is rarely used today.
Alternative Names
Breast removal surgery
Description
While the patient is anesthetized (unconscious and pain-free), an incision is made into the breast. The breast tissue is removed from the overlying skin and the underlying muscle. When an axillary dissection is done, it is typically via the same incision.
One or two small plastic drains are usually left in place to prevent fluid from collecting in the space where the breast tissue used to be.
Your surgeon will decide when these drains are removed, typically when the amount of fluid draining decreases to an acceptable volume. This may take a few days to a week or more. Many women go home with their drains and have them removed during an office visit.
It is possible to reconstruct the breast (with artificial implants or native tissue) at the same operation (immediate reconstruction) or at a later date, after other necessary treatments are given (delayed reconstruction).
Reconstruction adds to the complexity of the surgery. Decisions about whether to undergo breast reconstruction, and the best timing are joint decisions between women and their doctors. It involves the consideration of many different individual factors.
Indications
The most common reason for performing a mastectomy is breast cancer. Mastectomy is an alternative to breast conservation surgery. Which type of surgery is best for you is a complex decision. If you are diagnosed with breast cancer, discuss with your doctor the relevant issues for your circumstances thoroughly and in as much detail as you need. Important issues include the size of the tumor in relation to the size of your breast, whether there is more than one tumor in your breast, the side effects of radiation therapy, and your personal preferences.
Another reason for performing a mastectomy is when a breast contains widespread ductal carcinoma in situ (DCIS). DCIS is a pre-cancerous condition, and has the potential to become invasive cancer if left in place. It is typically discovered when a suspicious mammogram alerts your doctor to perform a biopsy.
DCIS present in a small area can be removed with a lumpectomy, but when spread throughout the entire breast, might require a mastectomy. When mastectomy is done for DCIS, it usually does not require removal of the lymph nodes under the arm.
Prophylactic (preventative) mastectomy is the surgical removal of one or both breasts that do not contain cancer or DCIS. It is done to prevent or reduce the risk of breast cancer, and is considered an alternative to intensive screening. Prophylactic mastectomy should be done only after very careful consideration, which often includes genetic testing and a psychiatric evaluation.
A subcutaneous or a total mastectomy can be done. This surgery is an option to reduce the risk of breast cancer for women at extremely high risk of developing breast cancer.
Women who might consider prophylactic mastectomy include those with a strong family history of breast cancer, especially if relatives are diagnosed at a very early age.
Some families have a known genetic mutation that predisposes to breast cancer (BRCA1 or BRCA2), and individuals can be tested for these genes. Inherited mutations in these genes increase the lifetime risk of developing breast cancer. It is important to note that prophylactic mastectomy greatly reduces, but does not eliminate the risk of breast cancer.
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